鼻咽癌放疗前CT或MRI检查分期与预后关系的比较

背景与目的:影像学检查结果是鼻咽癌临床分期和确定治疗靶区的重要依据.本研究试图分析放疗前按CT或MRI检查分期与鼻咽癌患者预后的关系.方法:445例病理确诊的无转移初治鼻咽癌患者.根据治疗前影像学检查手段的不同,分为CT组230例,MRI组215例.全组患者均行常规放疗,局部晚期患者加用化疗.用Kaplan-Meier和Log-rank法计算和比较两组生存率,用Cox模型分析影响预后的凶素.结果:CT组1、2、3年生存率分别为96.9%,90.3%,85.3%,MRI组分别为98.6%,94.3%,92.3%,两组比较差异有显著性(x2=6.305,P=0.012).CT组与MRI组的l,2,3年无瘤生存率和无复发生存率比较差异均有显著性(P<0.05),MRI组优于CT组.单因素分析结果显示临床分期、N分期、分期方法和化疗是影响鼻咽癌预后的因素,多因素分析结果显示临床分期和分期方法是影响鼻咽癌患者预后的独立因素.结论:鼻咽癌放疗前行MRI检查分期较CT检查分期来确定放疗靶区可提高鼻咽癌患者的生存率和局控率,临床分期和分期方法是影响鼻咽癌患者预后的独立因素.

Correlation of imaging-based staging to prognosis of nasopharyngeal carcinoma: computed tomography versus magnetic resonance imaging

BACKGROUND & OBJECTIVE: Imaging results are important for clinical staging and irradiation target planning of nasopharyngeal carcinoma (NPC). This study tried to analyze the correlations of staging based on computed tomography (CT) and magnetic resonance imaging (MRI) before radiotherapy to prognosis of NPC. METHODS: Clinical data of 445 pathologically confirmed NPC patients with no metastasis were analyzed. CT was performed on 230 patients before treatment? MRI was performed on 215 patients. All patients received conventional radiotherapy, and some locally advanced patients received additional chemotherapy. Kaplan-Meier and log-rank tests were used to analyze and compare the survival rates of the two groups. Cox model was used to analyze prognostic factors. RESULTS: The 1-, 2-, and 3-year overall survival rates were significantly lower in CT group than in MRI group (96.9% vs. 98.6%, 90.3% vs. 94.3%, 85.3% vs. 92.3%, Chi2 =6.305, P=0.012). The 1-, 2-, and 3-year disease-free and relapse-free survival rates were also significantly lower in CT group than in MRI group (P<0.05). Univariate analysis showed that clinical stage, N stage, imaging method and chemotherapy were prognostic factors of NPC. Multivariate analysis showed that clinical stage and imaging method were independent prognostic factors of NPC. CONCLUSIONS: Determining target volume by MRI before radiotherapy can improve the survival rate and local control rate of NPC patients when compared with CT. Clinical stage and imaging method are independent prognostic factors of NPC patients.